It is beginning...

[Old_Mil]

Stumbled across this today...

"The Emergency Department of...Hospital in...provides an advanced and modern facility with a comfortable and inviting environment for patients and staff. Approximately...patients depend on...emergency services annually to provide the expertise and resources to diagnose and treat a variety of medical conditions. This opportunity offers...the support of an exceptional patient focused staff and administrative team as well as very competitive compensation and paid medical malpractice insurance including tail.

Requirements for this position include:
Physicians board certified in EM, IM, or FP with some ED experience
Advanced Registered Nurse Practitioners with some ED experience"

I'm telling you all, we had best get a handle on this before we find ourselves in the same boat as anesthesia.

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[southerndoc]

Handle on what? This has been going on for a long time. Some rural ED's have no physicians at nights and are only staffed by MLP's. We utilize MLP's in our ED's with great success.

 

[Old_Mil]

Handle on what? This has been going on for a long time. Some rural ED's have no physicians at nights and are only staffed by MLP's. We utilize MLP's in our ED's with great success.

At what point is it OK to cut off the independent practice rights of DNPs for a department?

1000 visits a year? 5000? 10k, 15k...50k?

And once you open the door, what mechanism do you use to keep them from replacing you at half the salary?

 

[OccupyTheED]

At what point is it OK to cut off the independent practice rights of DNPs for a department?

1000 visits a year? 5000? 10k, 15k...50k?

And once you open the door, what mechanism do you use to keep them from replacing you at half the salary?

When the bad outcomes start to pile up and when the difference in salary doesn't account for the RVU's lost. Like many other things I suspect the bottom line will be the deciding factor in how far this goes

 

[southerndoc]

At what point is it OK to cut off the independent practice rights of DNPs for a department?

1000 visits a year? 5000? 10k, 15k...50k?

And once you open the door, what mechanism do you use to keep them from replacing you at half the salary?

Whenever you're able to find a physician to work. If you can find a physician that will work in a 2k/yr department, then it's unacceptable to use a MLP to replace that physician.

Most of the time that MLP's practice "independently" (always with physician medical direction) is when the hospital is unable to find a physician willing to work there.

I should have clarified earlier that we utilize MLP's in our ED for our fast track patients and to help with procedures (laceration repair, I&D's) at our level II trauma center. Physicians see patients behind the MLP's when patients are seen in the main area of the ED. Didn't mean to imply we utilize MLP's as sole providers in our ED's.

 

[AlmostJesus]

If you look at locumtenens.com there are tons of openings for physicians in small towns which often includes covering the ED. In small towns, often times midlevels aren't encroaching on physician practice, they are their lifeline that keep them from being stuck with 1:2 call, etc.
That being said, in my experience working in a small town, I would prefer a physician any day.